Effects of intranasal mometasone furoate on blood pressure in patients with allergic rhinitis.

BACKGROUND: Nasal congestion as the main symptom in patients with allergic rhinitis can impair nasal breathing. It causes hypoxia and concomitant sympathetic system activation, which may also lead to increased blood pressure levels in these patients. OBJECTIVE: We postulated that appropriate therapy, including intranasal steroids, decreases blood pressure levels in patients with allergic rhinitis. METHODS: In our study, we investigated the effect of intranasal steroid (4 weeks of mometasone furoate) on blood pressure changes in 45 patients with allergic rhinitis whose main complaint was nasal congestion. We used ambulatory monitoring for determining blood pressure levels before and after intranasal steroid therapy. None of the patients had any other systemic diseases. RESULTS: We found a significant decrease of daytime systolic and diastolic blood pressures and mean blood pressure values (daytime systolic blood pressure: 120 vs. 117 mmHg, p = 0.024; daytime diastolic blood pressure: 73 vs. 71 mmHg, p = 0.027; daytime mean blood pressure: 86 vs. 83 mmHg, p = 0.007). Although insignificant, we also found lower night-time systolic and mean blood pressure values (nighttime systolic blood pressure: 109 vs. 107 mmHg, p = 0.182; nighttime mean blood pressure 77 vs. 73 mmHg, p = 0.116). CONCLUSIONS: We found that post-treatment daytime average systolic, diastolic, and mean arterial blood pressure levels were significantly lower compared to values obtained during exacerbation of allergic rhinitis. Decrease in blood pressure with treatment of allergic rhinitis and nasal congestion suggests that nasal congestion and impaired nasal respiration may affect blood pressure and potentially cause serious problems in hypertensive patients with allergic rhinitis.

Percutaneous closure of a tricuspid paravalvular leak with an Amplatzer duct occluder II via antegrade approach.

Paravalvular leaks are seen after valve-replacement surgery and most patients with these leaks are asymptomatic, probably due to the small size of the leak. Nevertheless, a paravalvular leak after tricuspid valve replacement is a rare complication and may cause severe haemoylsis and hepatic dysfunction. It is usually treated surgically. There are no data on percutaneous transcatheter closure of paravalvular leaks. In this report, we present a successful percutaneous closure of a paravalvular leak using an Amplatzer duct occluder II device after a tricuspid valve replacement in a patient with high operative risk who had also had mitral and aortic valve replacements.

Importance of urinary measurement of glutathione S-transferase in renal dysfunction patients after on- and off-pump coronary artery bypass surgery.

BACKGROUND: Acute renal failure (ARF) occurring after on-pump and off-pump cardiac surgery was assessed by urinary alpha glutathione S-transferase measurement (alpha-GST) in patients who already had renal dysfunction. METHODS: Fifty-one patients with plasma creatinine levels ranging between 1.5 and 2.0 mg/dL were included in the study. On-pump coronary artery bypass was performed in 25 of them, and off-pump surgery in the other 25 patients. Urinary alpha-GST levels, plasma creatinine levels, creatinine clearance and fractional excretion of sodium were measured. RESULTS: Urinary alpha-GST levels were found to be significantly increased at 24 hours postoperatively. A weak correlation was detected between alpha-GST levels and plasma creatinine, creatinine clearance and fractional excretion of sodium. Preoperative and postoperative 24 hour levels showed a positive predictive value for the occurrence of acute renal failure. CONCLUSIONS: Tubular damage produced by cardiopulmonary bypass is not the only factor associated with postoperative ARF. Because factors independent of pump usage can adversely affect renal function, excluding pump usage alone is not sufficient to prevent postoperative ARF in patients who have preoperative renal dysfunction.

Leptin, soluble interleukin-6 receptor, C-reactive protein and soluble vascular cell adhesion molecule-1 levels in human coronary atherosclerotic plaque.

The aim of the present study was to explore the relationship between tissue levels of leptin, soluble interleukin-6 receptor (sIL-6R), high-sensitive-C-reactive protein (hs-CRP) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in atherosclerotic plaques, and traditional risk factors. Coronary artery specimens were obtained from 35 consecutive patients (26 men and nine women) who underwent coronary artery bypass grafting procedure. The mean tissue levels of leptin, hs-CRP and sIL-6R were significantly higher in patients with diabetes mellitus than without diabetes mellitus. When patients were classified according to the smoking status, the mean tissue levels of leptin, hs-CRP and sIL-6R were significantly higher in current smokers than both former smokers and non-smokers. In addition, the mean tissue levels of leptin and sIL-6R were significantly higher in former smokers than non-smokers. There was a positive association between leptin and hs-CRP, sIL-6R and plasma glucose in all patients. Plasma HDL levels were associated negatively with atherosclerotic tissue levels of leptin. Tissue levels of sIL-6R were associated significantly in a positive manner with leptin, hs-CRP and plasma glucose, while tissue levels of hs-CRP were associated with both leptin and sIL-6R. In conclusion, it is attractive to speculate that hs-CRP, sIL-6R and leptin could act synergistically in course of local inflammatory activity and those molecules may not be just markers of inflammation and cardiovascular risk but are also likely to play a pathogenic role in atheromatous plaque. In addition, atherosclerotic tissue levels of CRP, sIL-6R and leptin were significantly higher in current smokers and patients with diabetes.

Primary chylopericardium.

Primary chylopericardium is a rare entity. Here we describe a 36-year-old, asymptomatic male in whom pericardial effusion was detected by chest X-ray and echocardiography on routine health control. After pericardiocentesis that revealed the chylous nature of the fluid, partial pericardiectomy without duct ligation was carried out. In the follow-up period, there was no evidence of pericardial fluid on chest X-ray and echocardiography, at three months after the procedure.

The significance of elevated brain natriuretic peptide levels in chronic obstructive pulmonary disease.

We investigated the clinical significance of brain natriuretic peptide (BNP), a cardiac hormone, in chronic obstructive pulmonary disease (COPD). Subjects were 38 patients with stable COPD, of whom 20 had cor pulmonale (CP), and 22 were healthy individuals. Plasma BNP levels were measured and pulmonary arterial pressure (PAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also recorded. BNP levels of patients with COPD were higher than those of controls (48.2 +/- 37.5 and 9.3 +/- 3.0 pg/ml). Patients with CP had a higher mean BNP level with respect to those without CP (73.9 +/- 35.8 and 21.0 +/- 10.2 pg/ml, respectively). BNP levels correlated with PAP (r = 0.68), partial arterial oxygen pressure (r = -0.70), FEV1 (r = -0.65) and FVC (r = -0.52). We have concluded that BNP determination has a role in the diagnosis of CP in patients with COPD.

Brain natriuretic peptide and the severity of aortic regurgitation: is there any correlation?

We aimed to evaluate the correlation between aortic regurgitation severity and brain natriuretic (BNP) levels as a marker for left ventricular dysfunction. Sixty consecutive male patients (mean age 22 +/- 3 years) with isolated chronic aortic regurgitation were enrolled in the study together with a control group of 30 age-matched healthy volunteers (group A). Patients were classified with regard to aortic regurgitation vena contracta width as follows: group B, < 3 mm, mild (n = 16); group C, > or = 3 and < 6 mm, moderate (n = 26); group D, > or = 6 mm, severe (n = 18). BNP measurements were performed with a fluorescence immunoassay kit. BNP levels were increased in patients with aortic regurgitation, and severity of regurgitation had a significant influence on BNP levels. This effect can be explained by the volume loading effect of aortic regurgitation.